CAJ | 학술논문

目的研究主动脉瓣置换术后远期病人生活质量指数的变化,并评估瓣膜-病人不匹配对老年人主动脉瓣置换术后改善生活质量的影响.方法使用了前瞻性研究设计,将1995年8月10日到1998年8月19日期间,在我医疗中心实施单纯主动脉瓣置换术或同时施行冠状动脉旁路移植术,且年龄在70岁以上的100例病人列入本研究.临床随访定期在术后4周、6个月、以后每隔一年进行,收集并比较分析病人长期生存,跨瓣压差等数据;生活质量采用短期健康调查表(SF-36量表)问卷评估.结果病人年龄为(74.7±5.7)岁(范围70～87岁),随访(7.3±4.7)年,术后30 d死亡率,病人-瓣膜不匹配组6.3%,病人-瓣膜匹配组,3.3%.在第1年、第3年、第5年随访,病人长期生存率在组间并未表现出显著差异,但第7年随访,病人-瓣膜匹配与不匹配组两组间差异显著.在第1、第5年随访点,心脏超声数据显示病人-瓣膜匹配与不匹配组两组间跨主动脉平均压差差异显著,在随访的大多数点位上,病人的一般健康状况、体力/活力较术前都有所改善.社会活动、精神健康评估在第3、5和7个年的随访中较术前没有显着改善;而情感、社会活动,尤其是精神健康评估在术后第1年的随访中较术前有非常显著的改善,但组间差异不明显.结论老年患者主动脉瓣置换术后生活质量改善,但在生活质量的改善程度似乎与病人-瓣膜不匹配不相关.病人-瓣膜不匹配对主动脉瓣置换术后临床结果的影响仍然是一个有争议的问题.
목적 연구주동맥판치환술후원기병인생활질량지수적변화,병평고판막-병인불필배대노년인주동맥판치환술후개선생활질량적영향.방법 사용료전첨성연구설계,장1995년8월10일도1998년8월19일기간,재아의료중심실시단순주동맥판치환술혹동시시행관상동맥방로이식술,차년령재70세이상적100례병인렬입본연구.림상수방정기재술후4주、6개월、이후매격일년진행,수집병비교분석병인장기생존,과판압차등수거;생활질량채용단기건강조사표(SF-36량표)문권평고.결과 병인년령위(74.7±5.7)세(범위70～87세),수방(7.3±4.7)년,술후30 d사망솔,병인-판막불필배조6.3%,병인-판막필배조,3.3%.재제1년、제3년、제5년수방,병인장기생존솔재조간병미표현출현저차이,단제7년수방,병인-판막필배여불필배조량조간차이현저.재제1、제5년수방점,심장초성수거현시병인-판막필배여불필배조량조간과주동맥평균압차차이현저,재수방적대다수점위상,병인적일반건강상황、체력/활력교술전도유소개선.사회활동、정신건강평고재제3、5화7개년적수방중교술전몰유현착개선;이정감、사회활동,우기시정신건강평고재술후제1년적수방중교술전유비상현저적개선,단조간차이불명현.결론 노년환자주동맥판치환술후생활질량개선,단재생활질량적개선정도사호여병인-판막불필배불상관.병인-판막불필배대주동맥판치환술후림상결과적영향잉연시일개유쟁의적문제.
Objective To evaluate the long-term changes in the quality of life (QOL) scores in elderly patients after aortic valve replacement, and assess the impact of prosthesis-patient mismatch on the QQL of the patients. Methods A prospective cohort study was conducted involving 100 consecutive elderly patients above 70 years of age, who underwent isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft (CABG) procedures between August 10, 1995 and August 19, 1998. Patient-prosthesis mismatch (PPM) was defined as a prosthetic aortic valve EOAI of 0.85 cm~2/m~2 or less. The clinical follow-up examinations were carried out at 4 weeks and 6 months after the operation, and then annually afterwards. Cumulative and comparative analyses of the long-term outcomes and gradient pressure of the prosthetic valve were performed. The QOL of the patients was evaluated using the Short Form 36-Item Health Survey (SF-36) questionnaire. Results The mean age of the patients at prosthesis implantation was 74.7±5.7 years (range 70-87 years). The patients were followed up for a mean of 7.3±4.5 years. The thirty-day mortality was 6.3% in the mismatch group, and 3.3% in the matching group. The freedom from death showed no significant difference between the two groups at the first, third and fifth years after the prosthetic implantation, but differed significantly at the seventh year. The echocardiographic data showed significant differences in the mean gradient pressure between the two groups at the first and fifth years postoperatively. At most of the time points for follow-up examination, the general health and energy/vitality of the patients all improved from the preoperative levels, but no significant improvement was found at the third, fifth, and seventh years in the role emotional, social role, or general mental health; at the first postoperative year, however, the role emotional, social role, and particularly mental health, presented with significant improvements in comparison with the preoperative levels. No obvious difference in the QOL was noted between the two groups at the time points of observation. Conclusions Aortic vale replacement improves the QOL of the elderly patients, but the degree of improvements do not seem to be influenced by PPM. The interpretation of the impact of PPM on the clinic outcome of the patients still remains controversial.